| NPI | 1730602319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY W SHELBOURNE Owner 843-853-5859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 3426) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2022-07-21 |